Dystocia and Dysfunctional Labor

Dystocia

• Defined as difficult labor indicating complications during childbirth.

Main Components of Labor

• Power: Refers to uterine contractions responsible for moving the fetus through the birth canal.
• Passenger: Represents the fetus.
• Passageway: Indicates the birth canal.
• Psyche: Encompasses the perception and emotional response of the woman and her family regarding labor.

Dysfunctional Labor

• Current terminology for inertia, indicating ineffective labor patterns.

Inertia

• A term describing sluggish uterine contractions resulting in weak labor force.

Common Causes of Dysfunctional Labor

• Inappropriate use of analgesia.
• Pelvic bone contraction narrowing the birth canal, e.g., rickets.
• Poor fetal position, specifically head extension rather than flexion.
• Uterine overdistention from conditions like multiple gestation or hydramnios.
• Cervical rigidity due to full rectum or urinary bladder impeding fetal descent.
• Maternal exhaustion or first-time labor (primigravida status).

Uterine Contractions

• Fundamental mechanism propelling the fetus through the birth canal.

Oxytocin

• Hormone that significantly increases uterine contraction strength and frequency; can initiate labor if necessary.

Hypotonic Contractions

• Occur post-analgesia or due to complications like uterine overstretching or laxity (e.g., grand multiparity).

Contraction Frequency

• During hypotonic contractions, only 2-3 contractions may occur within a 10-minute period.

Hypertonic Contractions

• Characterized by excessive uterine activity; typically 15 mmHg is the resting tone.
• Results from multiple pacemakers stimulating contractions or myometrial fibers failing to relax post-contraction.

Latent Phase

• Stage of labor where hypertonic contractions are most prevalent.

Precipitate Labor

• Defined as very rapid labor, characterized by intense contractions leading to quick delivery.

Facilitators of Precipitate Labor

• Conditions such as grandmultiparity or the induction of labor with oxytocin can increase the likelihood of precipitate labor.

Risks for Fetus in Precipitate Labor

• Potential occurrence of subdural hemorrhage due to rapid delivery.

Risks for Mother in Precipitate Labor

• Possible birth canal lacerations, uterine bleeding, shock, and increased risk of infection.

Causes of Precipitate Labor

• Strong, efficient uterine contractions.
• A smooth birth canal facilitating rapid delivery.
• Previous history of precipitate labor.
• Smaller than average fetal size.
• Labor induction through prostaglandin use or fertility treatments.

Signs and Symptoms of Precipitate Labor

• Sudden onset of closely spaced intense contractions.
• Persistent and painful contractions.
• Urge to bear down, resembling a bowel movement.
• Immediate need to pass stools.

Risks for Babies during Precipitate Labor

• Increased likelihood of infections or aspiration of meconium and amniotic fluid during rapid delivery.